| NPI | 1154921179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH FREIHOFNER Owner 267-738-5078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224900000X Mastectomy Fitter |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |